A part of the team

Just finished my sixth shift on the CCU and you know, I'm really starting to feel more comfortable on the unit.These last few days have been a little slow, with 5-6 rooms vacant in our hallway. I've been spending a lot of time reading whatever educational material they have in English, from "Returning to a normal life after a heart attack" to "Eating healthy with Diabetes." The other nurses have started asking me if I want to watch them perform different procedures. Today I got to watch a nurse take an arterial blood gas or (ABG).

Arterial blood samples help health professionals determine how much oxygen is in the blood and whether blood pH is normal. ABGs are used to diagnose a number of illnesses, including heart, liver and kidney failure. So I walk into the patient's room just as the nurse is sitting down to the patient's bedside. She's got her gloves on and she's holding a syringe (3-4 inches?). Attached to the needle is a little vial used for collecting blood. She carefully felt the wrist for the patient's pulse and then slowly stuck the needle ALL THE WAY into his wrist. I think I must have cringed in disbelief, trying to imagine how much that must hurt! YOOOOOWWW!! Seeing no blood immediately enter the vial (which meant she hadn't found the artery) the nurse moves the needle around slowly in a semi-circular motion while at the same time pulling the needle in and out ever so slightly, looking for the artery. Suddenly, there's blood in the vial and within a couple seconds, it's full and she extracts the needle from the patient's wrist. The patient tolerated the procedure relatively well, I never even heard him make a peep. Maybe he fainted? I almost did! I hope I never have to get one of those done when I'm conscious!

12:37 call to Hamad General to pick up a patient!!! I think I mentioned that the CCU goes from being really really quiet to really really busy. With just over an hour left in my shift, I was already looking forward to, well, washing my face when I got home (my second favourite thing to do when I leave the hospital). Soumya walked up to me and asked me if I wanted to accompany one of the other nurses to Hamad to pick up a patient from the ER. I tried to maintain some sort of professionalism. OH BOY!! I thought, this is going to be exciting. Within seconds I was carrying a backpack full of emergency equipment (in case the patient should go into cardiac arrest en route) and following the nurse down to the ER where we picked up a doctor, went out the back door and jumped into an idling ambulance. The paramedics turned on the flashing lights for the 10-minute drive to the hospital (that was pretty exciting, I'm not going to lie). Sitting in the back, I hung on tightly to whatever sturdy object I could. We pulled up to Hamad and went directly to the ER, a small overly crowded room full of doctors and nurses. Sorry, I should clarify: this was the men's ER. I hear the women's ER is much nicer. Only a few patients were visible, including ours, a man who had recently arrived in Qatar from traveling abroad with chest pain and shortness of breath. After a brief exchange, the doctor said "let's go" and the paramedics transferred the man onto the stretcher and wheeled him back to the ambulance and we jumped in.

When we arrived back at the Heart Hospital, the man was immediately brought up to the cath lab, as it was suspected he was having a heart attack. Being Saturday, a cardiologist was paged to come in and perform an emergency angiogram to see if any of the man's arteries were blocked. Since this was  an emergency, the catheter was inserted into the man's arm, instead of his leg. Within minutes, the radioactive dye was injected into his heart and his arteries appeared on a large screen before us.
I'll pause here to say that there is something really fascinating about watching this procedure unfold. I can see why people are drawn to the cath lab: every patient is different, every circumstance unique. Each time a patient arrives, it's a mystery that needs to be solved.

Besides having a massive heart, the patient's arteries were normal and doctors attributed his chest pain and shortness of breath to some other cause, possibly stress.

Here's a photo of our dinner at Villagio the other night.

The Mall (Villagio)

So we went to the mall yesterday, but this was no ordinary mall! This is the Villagio! The first thing you notice are the gondolas and fake canals which wind their way through the entire mall, up and down every aisle. Throughout the mall there are white marble bridges to get from one side of the canal to the other. Above the European facade, the ceiling is painted a soft baby blue with puffy white clouds. Ahhhhhhhhhh..I almost feel like I’m in Venice….except for the amusement park and the skating rink. That’s right, Villagio has both of those things.

Laura and I wandered around for a couple of hours, popping in and out of stores and taking in the spectacle. Since Thursday night is the start of the weekend for Qataris (Friday is the day of congregational worship in the Gulf), the mall was packed. And, like back home, there were a lot of Qatari teenagers. In case you were wondering, Qatari teenagers act the same as teenagers back home: they hang out in packs and check themselves out in mirrors and windows.

I, too, was also surprised to learn of the Doha Ice Skating Club. Feeling a bit peckish, the four of us decided to try a Persian restaurant for dinner. There are a number of full-sized restaurants right in the mall, each of which has their own "patio" area where diners can sit and people watch. As we were eating, three Qatari women, with two children between them (ages 1.5 and 3 if I had to guess), came in and sat down. With them were two Filipino nannies - one for each child. Apparently this is quite common here. Actually, it's not uncommon for a Qatari family to have a nanny, a chef, a driver, well you get the picture. While the women sat and ate their dinner, the nannies watched the children, following them as they ran around tables, almost into the kitchen, out in the mall area, etc. None of the restaurant staff even batted an eye. The women neither spoke to, nor acknowledged the nannies whom, I should mention, were in uniform (scrubs). We all agreed the scene left a bad taste in our mouths, especially the way the women didn't speak to the nannies, let alone offer them something to eat or drink.

Blame it on the vein

One of the goals I set out for myself during my four weeks in Qatar was to start an IV and/or to take blood from a vein, a real vein. In the days before I left, I watched and re-watched all those "how to" videos on YouTube that can often be a nursing student's saving grace when trying to learn a new procedure (after reading the text books and completing our IV lab, of course). In the first few days in ER at the Heart Hospital my colleagues, Tanis and Natalia, both got to start IVs and have done it several times since. This is one thing I have to do before I leave, I thought. After a week on the CCU in Heart Hospital, yesterday I thought "today's the day." I'm ready. I can do this. Let's go.
Assigned to the same patient as the previous day, my preceptor, Souyma, and I wouldn't need to insert an IV as the patient had had one inserted in the ER before coming up to see us. About half way through the shift, however, she walks up to me with some supplies in hand, including a vacutainer, a wee little device used to draw blood from a person's vein. Oh. I hadn't realized the patient needed to have some blood withdrawn.

Would this be my chance to insert a needle into a vein? A real vein? My heart started pumping a little faster.  Deep breath, Lauren. Deep breath. My nurse turned to me and said "You will do this, yes?" And I replied:  "Yes, as long as you help me, Soumya?" (Don't leave my side, I secretly prayed). She nodded (I should mention that Soumya is an amazing preceptor).

Souyma prepped the patient and located an appropriate vein on the man's hand. She explained the procedure to him, then looked at me with a little smile. Ok, I thought. Here we go. I put on some gloves and wiped his hand with an alcohol swab. I opened the vacutainer and leaned over my patient, looking carefully at his hand and at the target vein. Then I went for it. Slowly, at first, probably too slowly. The patient starting speaking quickly in Hindi, I'm pretty sure it was an expression of pain (discernible in any language). Souyma was right by my side, instructing me to insert it a little further and then attach a small tube collecting a blood sample. If this was an IV insertion, I would have immediately been able to see flashback (blood) and known that I had hit the vein. But with a vacutainer, it's not immediately apparent that I was in the vein. I attached the tube and immediately it began to fill with blood. I was in the vein! It all happened so quickly, I didn't even have time to be nervous. We finished up and put some gauze on the patient's hand. He was doing well. My hands, which I anticipated would be a little on the shaky side, were steady throughout. No matter how many times you draw blood from a patient during your practice as a nurse, you never forget your first time!

Acute stent thrombosis

Back in Calgary, there's no better feeling than stepping out into the fresh air after a long shift and the same goes for here in Qatar. I finished at 10 p.m. last night and went downstairs to the lobby to wait for Tanis and Natalia who were also finished at 10 p.m. I actually wanted to stand outside for a few minutes to warm up because it's so cold on the unit (future Qatar exchange students: bring a sweater for the unit!)

If you look closely, you'll see a small group of people in purple uniforms - those are the nurses. All the female nurses wear the same uniform: white shirt with pink and red hearts, light purple pants and jacket. Male nurses usually wear green scrubs. The Hamad Medical Corporation provides free accommodations for nurses and transportation to and from the hospital, a small bus will pick them up after work and take them home.
It was a bit of an intense shift today. When I arrived, my preceptor, Soumya (I'll introduce her later) and I were assigned the same patient as the previous day. I completed my assessment, and my patient was stable and resting comfortably when.....
All of a sudden I heard a commotion across the hall. I stepped outside just in time to see about half a dozen nurses and doctors rush into a patient's room. I wandered over, trying to catch a glimpse of what was happening but the curtain in front of his bed had been pulled shut. A young woman wearing a chador (a black, traditional full-body cloak) was crying outside the patient's room, surrounded by several other women. Inside, a middle-aged man lay flat on the bed with his eyes open, blinking slowly. The nurses were hooking him up to an ECG as the doctors checked his vital signs. I quickly slid into the room and stood behind some of the nurses to observe what was happening. I learned that he had been speaking to his daughter when he lost consciousness. His heart rate dropped to 45 beats per minute (normal heart rate is 60-100 beats per minute). What's interesting is that this patient was supposed to have been discharged that morning and was just waiting for the final papers to be signed before he could go home. Earlier in the week he had had an angioplasty to open the blocked arteries in his heart. He'd had three bare-metal stents (see photo) inserted to help keep the blood flowing through his arteries.

Bare-metal stent

The doctors decided that the patient needed to have an emergency angioplasty performed and within 10 minutes he was being wheeled to the cath lab to have this procedure done. Soumya told me I should follow him and watch the procedure, so I did. About half a dozen doctors and nurses accompanied the patient, along with his family. I remember thinking how calm his wife appeared as she kissed her husband's forehead right before he was wheeled into the procedure room.
I sat in the control room and watched everything on a large screen and through a window where I could see doctors and nurses in blue scrubs prep the patient for the procedure.

The nurses explained everything and answered all of my questions about what was happening and, most importantly, what exactly I was looking at on the screen. I can only describe it as looking at an x-ray: I could definitely make out the man's spine, that's the easy part, and I could see the image rise and fall with each breath. After staring at the screen for a long time, I realized there was another large almost transparent structure moving there as well, THE HEART! I could just barely make it out, or I could see something pumping but couldn't really see the heart itself, if that makes sense.  Several minutes later and the man's arteries had been injected with a special radioactive dye. The procedure room goes dark and, ah yes, there's the heart! Actually I could only see the arteries and veins surrounding the heart. The right coronary artery, which I learned should usually look like a large "C" from this particular angle, was showing a 100% block where a stent had been inserted earlier in the week, something called acute stent thrombosis. After some time, a very fine wire was visible on the x-ray machine, slowing winding its way up the artery toward the blocked stent. This fine wire was inserted into the man's femoral artery (beside the groin) and carefully threaded up to his heart. How crazy is that? This is how they reopen the blocked artery. Amazing! One thought occurred to me: how the heck did doctors ever figure out that they could perform this procedure? Science, always amazes me!
Afterwards, the radioactive dye could be seen flowing throughout the entire artery as it was no longer blocked. The man, who was awake for the procedure, returned to the CCU shortly afterwards, where his family was waiting for him.

In other news, a recent heart-friendly article from the Globe and Mail.

Salam wa aleikum (Peace be upon you)

Another quiet day on the unit today. We had a total of six empty beds, something that would never happen back in Calgary. I learned today that patients don't have goals of care designations here.  I'll explain what this is for those who don't know: goals of care are basically what interventions you do or do not want done to you if your heart stops of if you stop breathing. For example, an R1 designation means you want all possible interventions to save your life while a C2 designation means you only want your symptoms controlled and that's it. No chest compressions. No intubation. No surgery. In Qatar, if a person passes away, CPR is performed for up to two hours or until the family says stop, regardless of the person's age or diagnosis. I was told this was because Muslims believe that a person dies when it's god's will so if they can be saved, they're saved.  I also learned that when a Qatari dies, they are buried by sundown that same day, there is no viewing. If a person dies during the night then they have to be buried before sunrise the next morning.

And now for a funny story:

If you go and see an America movie here, they censor the love scenes by blacking out the screen and muting the sound until it's over. But one time, during a screening of The Lucky One,  they blacked the screen but forgot to mute the sound. So people could hear the love scene but not see it. My colleague said that everybody in the theatre was cheering.

Let's learn about the heart

Up at the crack of dawn this morning which means....drum roll please... I'm over my jet lag! *crowds cheering* I thought I'd take advantage of my well-rested brain and and teach myself how to read an ECG. I remember touching on it briefly in school but being told "most nurses don't need to know how to read an ECG," which I wish had been followed by a "but they really should learn anyways." I guess it was probably one of those things I told myself that I could learn later on in my own time but then never followed up....until I started working in a cardiac unit. If anyone has any good tools for learning this, I'm all ears!

Many hours later......

It was a quiet day on the unit today, our only patient, who was from Iran, was stable, independent and had about a dozen family members trickle in throughout the day. You could literally see his mood improve as the hours passed by. It's always nice to see patients with lots of family in to visit them. Here in Qatar, family is of the utmost importance and we definitely see that on our unit.  Family comes before anything else. "Many Arabs have a very different order of personal priorities to those of most westerners," writes Jeremy Williams in Don't they know it's Friday? "Arab reaction to their immediate family situations is generally far greater than that undertaken, or expected, in western society," he says.

Also different from western society is the responsibility of some male Qatari children to make decisions on behalf of females, if the father is no longer living. Case in point: an elderly woman with many children, let's say 6, needs to have a life saving procedure done but her husband has passed away. That decision, regardless of what she wants, rests with her eldest son, at least in this case. To complicate matters is the fact that if a Qatari wishes to have a medical procedure performed at a hospital in the U.K. or in the U.S. because it happens to specialize in that procedure, the Qatari government will fly them there and and pay for the procedure. They'll even send along one doctor and one nurse. No, really!

Throughout the hospital, there are separate areas for men and women to pray, wait and be admitted.


 I was feeling really good about the fact that I brought a lunch to work today. Wait, what was I thinking? The cafeteria sells really good Indian food for about $3 a plate. We may have to rethink that decision tomorrow. I went to put my lunch in the nurse's lounge only to discover there is no fridge in the nurses lounge. What the? But where do nurses put their lunch? My preceptor told me she has a big meal before she comes to work and then just brings along some snacks. Come to think of it, all the fridges I have ever seen in staff lounges in hospitals back home have been DISGUSTING!! Corners full of sticky old...who knows what? Lunches so old their owners have long forgotten about them and given up all ties to favoured tupperware pieces. I can't imagine not having a fridge for unit staff back home. There would be mutiny for sure! No big deal, I thought. I'll just let my lunch sit out on this counter for about four hours, it was only in the sun for a little while, it should be OK right? The counter looks pretty clean.....

Luckily it was someone's birthday and they brought in something to share:

Sorry lunch.

Something else I learned about nursing in Qatar: a new nurse makes about 6,300 Rial or $1,700 US dollars a month. And get this: each year the Hamad Medical Corporation, which oversees the Heart Hospital, will pay for one return plane ticket for each of its staff nurses.

Welcome to the CCU

Heart Hospital, 5:36 a.m.

Arrived at the Heart Hospital this morning with my heart pounding, a little. Aside from a security guard sitting just inside the front door, the hospital seemed deserted. After saying our goodbyes in the front foyer, Tanis and Natalia headed to the ER and I headed upstairs to the CCU. Deep breath.

I slipped inside the unit doors just as a body covered by a white sheet was being wheeled out. A couple of tall men in traditional white suits were following close behind, one wiping away a tear as he followed the stretcher out.

In the CCU, there is a 1:1 patient to nurse ratio because of the high acuity of the patients and there is only one person to a room. Glancing at the list of patients, most were in their 20s, 30s and 40s, admitted after a heart attack, often their first.  My patient, who also fit into this category, was scheduled for an angioplasty this morning. During this procedure, obstructed arteries are mechanically widened at the coronary catheterization lab on the same floor, down the hall. My nurse and I accompanied the patient there and they returned later that morning. Turns out this patient had an occlusion of the left anterior descending coronary artery, also called a "widow maker" according to one of our teachers in first year. I don't think I need to explain that one. 

OK, onto happier things....

The CCU is large, spacious and bright. Everything feels new and modern. No food or coffee in sight, not even at the nurse's station. Also, no clutter. Anywhere. What a difference! However, everyone wears perfume/cologne and talks on their cell phone often. All the equipment is different and the charting... ha! Don't even get me started on the charting! Everything is charted on enormous easel-sized pieces of paper full of grids and boxes organized according to date and time. There are separate boxes along the bottom that explain how to correctly abbreviate the data you put into the smaller boxes. I'm not saying it's a bad system, actually it's quite efficient, just takes some getting used to. Yeeesh! My nurse told me, quite confidently, that after one week I would have no trouble understanding this new system. I was (crazy) laughing on the inside.

I got to eavesdrop on some rounds today, which was pretty neat. I don't think doctors and nurses have the same kind of collaboration as in Canada. I definitely didn't see as much camaraderie although I did see some on the unit. But those nurses, boy do they know their stuff! My preceptor has worked on the unit for six years. But when she tried to explain an abnormal electrocardiogram or ECG (not actually the one below), I think I started to go cross-eyed. Hey, did I mention I had been up since 2:30 a.m?

At 11 we had a presentation from the hospital on infection prevention and control. That Middle East Respiratory Virus (MERS) you may have read about in the news? They've had five confirmed cases in Doha over the last few months. Tomorrow we're attending another information session, specifically about MERS.

We borrowed an empty resuscitation room to work out our hospital schedule over the next few weeks. Being the only area free of patients, we had to pose for a few pics, naturally. The day was: overwhelming but good.

Then we came home and watched funny Indian music videos by this guy:

Sure wished more singers made music videos like this.

https://www.youtube.com/watch?v=LuW53xh-gj8